- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,443.26 / $1,443.26 / $1,730.81
| Professional | | $1,443.26 | $1,443.26 | $1,730.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,524.18 / $1,732.75 / $2,561.03
| Professional | | $1,524.18 | $1,732.75 | $2,561.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,353.78 / $1,777.45 / $2,671.56
| Professional | | $1,353.78 | $1,777.45 | $2,671.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,447.13 / $1,863.79 / $2,859.15
| Professional | | $1,447.13 | $1,863.79 | $2,859.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,443.26 / $1,443.26 / $1,730.81
| Professional | | $1,443.26 | $1,443.26 | $1,730.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,350.39 / $1,863.79 / $2,506.53
| Professional | | $1,350.39 | $1,863.79 | $2,506.53 |